Provider Demographics
NPI:1992795546
Name:REYNOLDS, WILLIAM G (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 CHAMBLISS AVE NW
Mailing Address - Street 2:A
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3842
Mailing Address - Country:US
Mailing Address - Phone:423-476-7561
Mailing Address - Fax:423-559-0324
Practice Address - Street 1:2175 CHAMBLISS AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3842
Practice Address - Country:US
Practice Address - Phone:423-476-7561
Practice Address - Fax:423-559-0324
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000025611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics